Decree No. 314 / 2024 Coll.
Decision on the determination of the value of the point, the amount of the remuneration for the services paid and the regulatory restrictions for 2025
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Effective from 01.01.2025
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314
DECLARATION
of 25 October 2024
establishing the values of the points, the level of remuneration for the services covered and the regulatory restrictions for 2025
The Ministry of Health provides pursuant to § 17 (5) of Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related laws, as amended by Act No. 371 / 2021 Coll.:
(1) This Decree provides for 2025
(a) the value of the point;
(b) the amount of compensation paid to insured persons under Article 2 (1) of Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related acts, as amended ("the Act"),
(c) the level of reimbursement of paid services to insured persons from other Member States of the European Union, the Member States of the European Economic Area and the Swiss Confederation pursuant to the directly applicable provisions of the European Union relating to the coordination of social security systems (1), to UK insured persons under the Agreement on Trade and Cooperation (2) and to insured persons of other States with which the Czech Republic has concluded international social security agreements covering the field of paid services (3) (hereinafter referred to as "foreign insured persons"),
(d) a regulatory restriction on the remuneration for the services covered, referred to in Sections 4 to 20, provided by the contracting health service providers (hereinafter referred to as the provider).
(2) This decree applies to providers
(a) bed care;
(b) in the field of general practical medicine, as defined in the Decree issuing a list of health performances with points (4) (hereinafter referred to as "the list of performance"),
(c) in the field of practical medicine for children and youth according to the performance list;
(d) specialised outpatient care;
(e) dialysis healthcare;
(f) expertise 905, 919 and 927 according to the performance list;
(g) outpatient care in expertise 603 and 604 according to the performance list;
(h) dental medicine;
(i) outpatient care in the field of expertise 222, 801, 802, 806 to 810, 812 to 818 and 823 according to the performance list (hereinafter referred to as "the listed expertise"),
(j) outpatient care in expertise 914, 916 and 921 according to the performance list;
(k) home care in expertise 925 and 926 according to the performance list;
(l) outpatient care in expertise 902 and 917 according to the performance list;
(m) medical emergency services,
(n) the transport of patients with urgent care;
o) health transport services,
(p) medical emergency services,
(q) emergency dental services;
(r) spa rehabilitation and rehabilitation facilities;
(s) medical care; and
(t) day care.
(1) The reference period for the purposes of this Decree is 2023. The benchmark values of the provider shall be the values of the relevant payment indicators of the provider in the reference period.
(2) The evaluation period for the purposes of this Decree is 2025.
(3) All the services provided in 2023, the provider declared by 31 March 2024 and the health insurance company recognised by 31 May 2024 are included in the reference period.
(4) All the services provided in 2025, the provider reported by 31 March 2026 and the health insurance undertaking recognised by 31 May 2026 are included in the evaluation period.
(5) If two health insurance companies are merged in the assessment period, the sum of the data for the reference period of the merged health insurance companies shall be used for the calculation of the remuneration.
(1) For the purposes of this Order, a unique insurer shall mean an insurer of a health insurance undertaking treated by a provider in a specific professional capacity in the evaluation period or in the reference period at least once, unless otherwise specified.
(2) If a unique insured person has been treated by the provider in a particular professional period or in a reference period more than once, the number of unique insured persons shall include the relevant health insurance undertaking treated in that professional period and the period only once.
(3) In the event of a merger of health insurance undertakings, an insured person for whom more than one of the merged health insurance companies has been paid for during the evaluation period or in the reference period shall be included only once in the number of individual insured persons.
(4) For the purposes of this decree, a global unique insurer means an insurer of a health insurance undertaking treated by a sleeper care provider in any professional capacity in the context of own or requested health services in the evaluation period or in the reference period at least once, unless otherwise specified.
(5) Where a global unique insured person has been treated by the provider more than once in the evaluation period or in the reference period, regardless of the number of specialists in which the insured person has been treated, the number of global unique insured persons shall include the relevant health insurance companies treated with that provider only once.
(6) In the event of a merger of health insurance companies, an insurer for which more than one of the merged health insurance companies has been paid in the evaluation period or reference period, shall only be included once in the number of global unique insured persons.
(7) If the health insurance undertaking is to use the values of the remuneration indicators of comparable providers when determining the level of remuneration or regulatory restrictions, it shall use the relevant values of all contractual providers that provide health services in a comparable overall scale and structure over the evaluation period as the provider for which the provisions on comparable providers are applied.
(8) International classification of diseases for the purposes of this Decree means the International Statistical Classification of diseases and associated health problems in its current version (MKN-10) 5.
(9) For the purposes of this decree, office hours shall be those agreed in the contract between the health insurance company and the provider, where at least 1 health professional with specialised competence in the relevant field is available at the place of work of the insured person, excluding the period devoted to the visiting service and administrative activities.
In the case of the provision of paid services to foreign insured persons, the remuneration shall be determined in accordance with § 5 to 20.
(1) For paid services provided by bed care providers, with the exception of paid services provided by post-bed care providers, long-term bed care, social and health care or special bed care providers, the value of the point, the amount of payment of the paid services and the regulatory limit shall be set out in Annexes 1, 9, 10, 12 and 13 to this Decree.
(2) For paid services provided by post-bed care providers, long-term bed care, social and health care, special bed care or special outpatient care provided under § 22 (c) of the Act, the value of the point, the amount of payments of the services paid and the regulatory limit are set out in Annex 1 to this Decree.
For paid services provided by providers of general medical practice according to the list of performance and by providers in the field of practical medicine for children and youth according to the list of performance paid by the combined capitalisation payment, combined by the capitalisation payment with the top-up of the capitalisation or according to the list of performance, the value of the point, the amount of payment of the services paid and the regulatory limit shall be set out in Annex 2 to this decree.
For specialised outpatient care provided by outpatient care providers covered by the performance list, the value of the item, the amount of the payments of the services paid and the regulatory limit shall be as set out in Annex 3 to this Decree.
For outpatient care provided to outpatient care providers in expertise 603 and 604 according to the performance list paid under the performance list, the value of the point, the amount of payment of the services paid and the regulatory limitation shall be as set out in Annex 4 to this Decree.
The amount of the remuneration of the paid services provided by dental care providers and the relevant regulatory limit is set out in Annex 11 to this Decree.
For paid services provided by outpatient care providers in the listed expertise covered by the performance list, the value of the point and the amount of the payment of the services paid shall be as set out in Annex 5 to this Decree.
For paid services provided by outpatient care providers in expertise 914, 916, 921 and home care providers in expertise 925 and 926 according to the list of performances paid according to the list of performances, the value of the point and the amount of the payments of the services paid is set out in Annex 6 to this decree.
For paid services provided by outpatient care providers in expertise 902 and 917 according to the performance list covered by the performance list, the value of the point and the amount of payment of the services paid shall be as set out in Annex 7 to this Decree.
The value of the point and the amount of the payment of the services paid shall be set out in Annex 8 to this Decree for the services provided by the dialysis providers covered by the list of services.
(1) For paid services provided by the health rescue service provider and the transport of patients with urgent care covered by the performance list, the value of the point of CZK 1.31 shall be determined, with the exception of the transport performance according to the performance list, for which the value of the point of CZK 1.44 is determined, and with the exception of the performance with a point value (hereinafter referred to as "performance ') no. 06714 according to the performance list for which the value of the point of CZK 1.31 is determined.
(2) The reimbursement referred to in paragraph 1 shall be increased by CZK 1 550 for the provision of care to health insurance insurers including the receipt of an emergency call by the operator of the medical operating centre and the exit of the medical emergency service declared in accordance with paragraph 1.
(1) For the services provided by the health transport service provider, the amount of remuneration shall be determined on the basis of the performance list by remuneration for the services provided to the provider.
a) providing a 24-hour medical transport service with a value of CZK 1.44,
b) not providing a health service in continuous operation with a value of CZK 1.18.
(2) For the performance of transport No. 69 according to the list of performances, the value of the point is set at CZK 1.31.
(1) For the services provided by the provider under the medical emergency service paid according to the performance list, the value of the point of CZK 1,14 is determined for the performance, except for the performance of transport and power according to the performance list.
(2) Paragraph 9 shall apply in order to determine the level of remuneration of paid services provided by providers in the context of dental emergency services and to establish regulatory restrictions on such services.
(1) For complex spa rehabilitation care for adults, children and adolescents provided in the health facilities of the spa rehabilitation care provider, a payment for 1 day's stay of 103% of the contractually agreed remuneration for 1 day's stay for 2024 shall be provided. If the payment for 1 day's stay for 2024 has not been agreed on by 31 December 2024 inclusive, the remuneration shall be set at the level of the remuneration paid to comparable providers. The payment for the accommodation and food of the insured person's guide is set at the same amount as the payment for these components for insured persons who are provided with comprehensive spa rehabilitation care for adults.
(2) For the benefit of the spa rehabilitation care for adults, children and adolescents provided in the health facilities of the spa rehabilitation care provider, a payment for 1 day's stay shall be fixed at 103% of the contracted remuneration for 1 day's stay for 2024. If the payment for 1 day's stay for 2024 has not been agreed on by 31 December 2024 inclusive, the remuneration shall be set at the level of the remuneration paid to comparable providers.
(3) The value of the point of CZK 0.76 is determined for the spa rehabilitation care allowance for performance No. 09543 according to the list of performances. This performance may be declared to the insurance undertaking no more than three times during one medical stay of the insured person.
(4) For the services provided in the recovery rooms, the payment for 1 day's stay is set at CZK 1,284, which consists of the accommodation, catering and recovery programme component. The payment for the accommodation and food of the insured person's guide shall be set at the same rate as the payment for these components for the insured persons who are provided with the services paid at the health care centre.
(1) For performance No. 09543 according to the list of performances the value of the point is set at CZK 1.06. The first sentence shall not apply to the provider of spa rehabilitation care, which shall be treated in accordance with Paragraph 17 (3).
(2) For performances no. 09555 to 09557 according to the list of performances the value of the point is set at CZK 1.06.
(3) For performances Nos 09580 and 09581 according to the list of performances the value of the point is set at CZK 1.02.
(4) For each performance No. 09990 according to the list of performances, the payment is set at CZK 36.
(5) The remuneration referred to in paragraphs 1 to 4 does not enter into the calculation of the maximum, total or similar amount of remuneration for the services paid. Except as provided for in the second sentence of paragraph 1, paragraphs 1 to 4 shall not apply to covered overnight and bed care services.
(1) For each provider declared and the health insurance company recognised performance No. 09552 according to the list of performances, a remuneration of CZK 32 is determined.
(2) No later than 150 days after the end of the evaluation period, the health insurance company will pay the provider CZK 16 for each transfer of the paper recipe into electronic form if, on the basis of this recipe, a medicinal product covered by the public health insurance was issued to its insured person.
The amount of remuneration for overnight care services covered under the Health Services Act is set out in Annex 13 to this Decree.
This Decree shall take effect on 1 January 2025.
Minister:
Prof. MUDr. Válek, CSc., MBA, EBIR, v. r.
Příloha č. 1
Annex No 1
Value of the point, amount of payments of services paid and regulatory restrictions pursuant to § 5
A) Bounded services pursuant to § 5 (1)
1. The remuneration to the provider during the evaluation period shall include the contractually agreed remuneration component referred to in point 2, the flat-rate remuneration referred to in point 3, the remuneration allocated to the flat-rate payment referred to in point 4, the case flat-rate payment referred to in point 5, the payment for acute bed-keeping for a small number of insured persons and foreign insured persons referred to in point 6, the payment for outpatient care referred to in point 7 (the "outpatient remuneration component ') and the other remuneration referred to in point 8.
1.1 For the purposes of points 3 to 5, when calculating the variables in the reference period, hospitalisation cases shall mean hospitalisation cases converted according to the rules for the classification of hospitalised patients for the year 20256 (hereinafter referred to as "Classification ').
1.2 For the purposes of points 3 to 6, the requested extramural care shall mean care related to the hospitalisation of an insured person with a provider requested by the provider and provided to the insured person at the time of the hospitalisation of the provider by another provider that reports it to the health insurance undertaking.
1.3 For the performance of OD 00031 and 00032, the flat rate for the treatment day is set at CZK 561, these performances being excluded from the payment according to points 3 to 6. The services referred to in point 7.12 (c), if provided during the hospitalisation of the insured person, shall be exempt from the remuneration referred to in points 3 to 6 and shall be paid in accordance with point 7.
1.4 The medicinal products and medical devices listed in Annex 12 to this Decree shall be paid by the health insurance company to the provider at the level of their declared unit price, excluding those medicinal products and medical devices from the remuneration referred to in points 2.2 and 3 to 7.
1.5 For the purposes of points 3 to 8, a provider having the status of a high-level care centre shall be understood as a provider who, under the Health Services Act, holds the status of a high-level health care centre or a high-level health care centre for patients with rare diseases or a cooperating provider with such a provider for the purpose of granting or obtaining that status.
2. Individual contractually agreed payment component
2.1 If the health insurance undertaking and the provider agree on a different amount and method of payment of the services paid and for the services covered by the flat-rate payment, in the remuneration set out in the flat-rate payment or in the flat-rate payment, the remuneration for those services shall not be included in the remuneration referred to in points 3 to 6.
2.2 The amount of the reimbursement of medicinal products and food for special medical purposes (hereinafter referred to as "the medicinal product"), marked "S" in accordance with Article 39 (1) of Decree No 376 / 2011 Coll., implementing certain provisions of the Public Health Insurance Act (hereinafter referred to as "Decree No 376 / 2011 Coll.") and other medicinal products referred to in points 2.2.1 (c) and (d) (i. e. and 2.2.2 (q), shall be determined according to the provider of the declared and health insurance company of the recognised medicinal product at the unit price, but not exceeding the amount specified in points 2.2.1 to 2.2.3.
2.2.1. For medicinal products:
(a) to treat HIV / AIDS, spinal muscle atrophy, cystic fibrosis or hereditary angioedema,
(b) intended for the prophylaxis of children at risk exposed to respiratory syncytic virus exposure;
(c) ATC Group M09AX09; or
(d) submitted to insured persons under 18 years of age if:
i. Paid under Article 16 of the Act; or
ii. classified in the groups referred to in point 2.2.2, even if these medicinal products are used in the manner provided for in Section 8 (4) of the Drug Act,
the maximum remuneration per administered medicinal product shall be set at the level of the provider declared and recognised by the health insurance undertaking in 2023; This does not apply if these products have a fixed amount of remuneration under other legislation. The reimbursement of the medicinal products referred to in points (a) to (d) shall not enter into the calculation referred to in point 2.2.2.
2.2.2 For groups:
| a) | Dermatologie (aktinická keratóza, psoriáza těžká a jiná kožní onemocnění) |
| b) | Dýchací soustava 1 (astma, CHOPN) |
| c) | Dýchací soustava 2 (idiopatická plicní fibróza, intersticiální pneumonie) |
| d) | Endokrinologie (akromegalie, endokrinní oftalmopatie, toxická struma štítné žlázy, růstové hormony, hypoparathyreóza, achondroplázie, křivice) |
| e) | Hematoonkologie (leukemie, lymfomatózní meningitida, lymfomy, mnohočetný myelom, myelo-dysplastické syndromy, podpůrná hematoonkologie, zhoubné imunoproliferativní nemoci, hematologie) |
| f) | Imunitní systém (autoinflamatorní onemocnění, digitální ulcerace u systémové sklerodermie, polyangiitida, transplantace) |
| g) | Infekce (hepatitida C) |
| h) | Metabolické vady (Fabryho choroba, Gaucherova choroba, Niemann-Pickova choroba, metabolické vady) |
| i) | Neurologie 1 (epilepsie, narkolepsie, migréna, Parkinsonova choroba, substituční léčba) |
| j) | Neurologie 2 (roztroušená skleróza) |
| k) | Oběhový systém (plicní arteriální hypertenze, amyloidóza srdce, symptomatická hypertrofická obstrukční kardiomyopatie) |
| l) | Oftalmologie (centrální a periferní venózní okluze, choroidální neovaskularizace, věkem podmíněná makulární degenerace, oftalmologie – diabetes mellitus, vitreomakulární trakce, Leberova optická neuropatie, neinfekční uveitida, autologní buňky lidského rohovkového epitelu) |
| m) | Onkologie – solidní nádory (hepatocelulární karcinom, nádory hlavy a krku, nádory kolorekta, nádory ledviny, nádory močového ústrojí, nádory mozku, nádory ovarií a dělohy, nádory plic, nádory prostaty, nádory prsu, nádory slinivky, nádory štítné žlázy, nádory z embryonálních buněk, nádory žaludku, osteosarkom, neuroendokrinní tumory, sarkomy měkkých tkání, jiné nádory měkkých tkání, jiné zhoubné nádory kůže, kožní lymfomy, maligní melanom, mezoteliom pleury, hemangiom, gastrointestinální stromální tumory, neurofibrom) |
| n) | Revmatologie (Bechtěrevova choroba, artritida, systémový lupus erythematosus, psoriatická artritida) |
| o) | Trávicí soustava (Crohnova choroba, ulcerózní kolitida, syndrom krátkého střeva) |
| p) | Hepatologie – onemocnění jater a žlučových cest (sekundární trombocytopenie při onemocnění jater) |
| q) | |
| r) | Ostatní – ostatní léčivé přípravky označené symbolem „S“ podle § 39 odst. 1 vyhlášky č. 376/2011 Sb. |
the maximum remuneration for medicinal products administered to insured persons from the age of 18 shall be fixed as follows:
Uhrmax, 2025
where:
| Uhrmax,2025 | je maximální úhrada v |
| i | nabývá hodnot a až r, kde a až r jsou skupiny uvedené v bodě 2.2.2. |
| Uhri,2023 | je celková úhrada v roce 2023 za |
| INi | je index navýšení úhrady pro skupinu i, uvedený v bodě 2.2.3. |
The maximum remuneration is set for all groups together.
2.2.3 The index of the remuneration increase shall be set at:
| Skupina | Index navýšení úhrady |
|---|---|
| a) Dermatologie | 1,32 |
| b) Dýchací soustava 1 | 1,43 |
| c) Dýchací soustava 2 | 1,15 |
| d) Endokrinologie | 1,36 |
| e) Hematoonkologie | 1,18 |
| f) Imunitní systém | 1,20 |
| g) Infekce | 1,12 |
| h) Metabolické vady | 1,58 |
| i) Neurologie 1 | 1,45 |
| j) Neurologie 2 | 1,06 |
| k) Oběhový systém | 1,41 |
| l) Oftalmologie | 1,03 |
| m) Onkologie – solidní nádory | 1,36 |
| n) Revmatologie | 1,16 |
| o) Trávicí soustava | 1,12 |
| p) Hepatologie | 1,20 |
| q) Vyjmuté z Klasifikace | 1,20 |
| r) Ostatní | 1,28 |
2.2.4 Reimbursement for the treatment of medicinal products provided to insured persons during the evaluation period above the total reimbursement limit set out in points 2.2.1 to 2.2.3 shall be paid in accordance with a prior agreement between the health insurance undertaking and the provider.
3. Flat payment
3.1 The flat-rate payment shall include the services covered by the Classification in the groups related to the diagnosis listed in Annex 10, Part A, to this Decree.
3.2. The amount of the flat-rate remuneration shall be determined as the FOREIGN, CZK-DRG, 2025, depending on:
EMBRPU, CZ- DRG, 2025 = min {1; CMred, 2025, CZ- DRG, A0,98 * CM2023, CZ- DRG, A} * IPU * IZP-EM2025, A
where:
| CM2023,CZ–DRG,A | je počet případů |
| EM2025,A | je celková hodnota |
| min | funkce minimum, která vybere z oboru hodnot hodnotu nejnižší. |
and where the IPU is an individual flat-rate remuneration calculated as follows:
(a) IPU = Pudrag, 2023 * 1,095
where:
| PUdrg,2023 | je referenční výše úhrady za |
Pudrag, 2023 = max {CM2023, CZ- DRG, A-D * ZSmin, 2023, PU; EMBRPU, CZ- DRG, 2023 + EMBRIS, A-D2023 + EM2023, A-D} * (CM2023, CZ- DRG, ACM2023, CZ- DRG, A-D)
where:
| CM2023,CZ–DRG,A–D | je počet případů hospitalizací přepočtených podle bodu 1.1 poskytovatelem vykázaných a zdravotní pojišťovnou uznaných, ukončených v referenčním období, zařazených podle Klasifikace do skupin vztažených k diagnóze uvedených v příloze č. 10, částech A až D k této vyhlášce, vynásobených relativními váhami 2025 uvedenými v příloze č. 10, částech A až D k této vyhlášce. |
| ÚHRPU,CZ–DRG,2023 | je celková výše paušální úhrady uhrazená poskytovateli v referenčním období. |
| EM2023,A–D | je celková hodnota vyžádané extramurální péče v rámci případů hospitalizací přepočtených podle bodu 1.1 poskytovatelem vykázaných a zdravotní pojišťovnou uznaných, ukončených v referenčním období, zařazených podle Klasifikace do skupin vztažených k diagnóze podle přílohy č. 10, částí A až D k této vyhlášce, oceněná hodnotami bodu platnými v referenčním období, včetně úhrady za zvlášť účtovaný materiál a zvlášť účtované léčivé přípravky. |
| je celková úhrada poskytovateli za případy hospitalizací zařazené do individuálně smluvně sjednaných bází v referenčním období, a zároveň zařazené podle Klasifikace do skupin vztažených k diagnóze uvedených v příloze č. 10, částech A až D k této vyhlášce. | |
| max | funkce maximum, která vybere z oboru hodnot hodnotu nejvyšší. |
| ZSmin,2023,PU | je minimální základní sazba, která se stanoví ve výši 68 000 pro poskytovatele, který má statut centra vysoce specializované traumatologické péče a zároveň alespoň další 3 statuty center vysoce specializované péče nebo má alespoň 6 různých statutů center vysoce specializované péče podle zákona o zdravotních službách. Pro ostatní poskytovatele se minimální základní sazba stanoví následovně: |
ZSmin, 2023, PU = max (MIN2023, PU; 0,5 * ZS2023, median + 0,5 * IZS2023, PU)
where:
| MIN2023,PU | nabývá hodnoty 55 000 pro |
| ZS2023,median | nabývá hodnoty 60 000 pro |
| IZS2023,PU | je referenční individuální základní sazba pro paušální úhradu, která se vypočte následovně: |
IZS2023, PU = FOREIGN, CZ- DRG, 2023 + FOREIGN, A-D2023 + EM2023, A-DCM2023, CZ- DRG, A-D
(b) CMred, 2025, CZ-DRG, A is calculated as follows:
| i. | Pokud je počet |
CMred, 2025, CZ-DRG, A = CM2025, CZ-DRG, A
where:
| CM2025,CZ–DRG,A | je počet případů |
| PPRdrg,A,2025,5 | je počet případů |
| PPRdrg,A,2023,5 | je počet případů |
| PPdrg,A,2025 | je počet případů |
| PPdrg,A,2023 | je počet případů |
| ii. | V ostatních případech se redukovaný casemix stanoví takto: |
CMred, 2025, CZ- DRG, A = CM1,2025, CZ- DRG, A + CMred.5
where:
| CM1,2025,CZ–DRG,A | je počet případů |
And where:
CMred, 5 = CM2025, CZ- DRG, A, 5 * min [1; (X * PPRdrg, A, 2023,5PPRdrg, A, 2025,5 * PPdrg, A, 2025PPdrg, A, 2025PPdrg, 2023)]
where:
| CM2025,CZ–DRG,A,5 | je počet případů |
| X | nabývá hodnoty 1,1 v případě, kdy je koeficient poměru počtu |
(c) IZP is the index of the change in production calculated as follows:
IZP = max [1; ARCTG (3 * CM red, 2025, CZ- DRG, ACM2023, CZ- DRG, A-1,443)]
4. Reimbursement on flat-rate remuneration
4.1 The remuneration earmarked for the flat-rate remuneration shall include the services covered by the Classification in the groups related to the diagnosis listed in Annex 10, Parts C and E to this Order.
4.2 For the services covered by the flat-rate remuneration classified under the classification in the groups related to the diagnosis listed in Annex 10, Parts C and E by the provider recognised and the health insurance undertaking recognised for the period of assessment, a remuneration shall be set at:
OJ C 369, 17.12.2015, p.
where:
| CM2025,CZ–DRG,CE,ij | je případ |
| ÚHRJPL,ij | je výše úhrady jednodenní péče pro případ |
| KCCE,i | je koeficient centralizace, který se stanoví pro skupinu i vztaženou k diagnóze a uvedenou v příloze č. 10, částech C a E k této vyhlášce, ve výši 1,05, pokud |
| EM2025,CE | je celková hodnota |
| IZS2025,CZ–DRG,CE | je individuální základní sazba pro péči vyčleněnou z paušální úhrady, která se vypočte následovně: |
(1) Where:
IZSENTRI, 2025 ≥ (1 + RCCE, upper) * ZSCZ-DRG
then:
IZS2025, CZK-DRG, CE = TSCE, upper * (1 + RCCE, upper) * ZSCZ-DRG + (1 - TSCE, upper) * IZSadmission, 2025
(2) Where:
IZSinput, 2025 ≤ (1-RCCE, lower) * ZSCZ-DRG
then:
IZS2025, CZ- DRG, CE = TSCE, lower * (1-RCCE, lower) * ZSCZ-DRG + (1-TSCE, lower) * IZSventni, 2025
(3) In other cases:
IZS2025, CZ-DRG, CE = IZSadmission, 2025
where:
| IZSvstupni,2025 | je vstupní individuální základní sazba vypočtená následovně: |
IZSENTRI, 2025 = {(FOREIGN, 2023 + FOREIGN, EF2023 + EM2023, EF) * (CM2023, CZ- DRG, ECM2023, CZ- DRG, EF) + (CM2023, CZ- DRG, CCM2023, CZ- DRG, A) * Pudrg, 2023} CM2023, CZ- DRG, CE * 1,095
where:
| ÚHRvyčl,2023 | je celková výše úhrady za poskytovatelem vykázané a zdravotní pojišťovnou uznané hrazené služby, poskytnuté během hospitalizací přepočtených podle bodu 1.1 ukončených v referenčním období, které byly v referenčním období hrazeny úhradou vyčleněnou z paušální úhrady. |
| je celková úhrada poskytovateli za případy hospitalizací zařazené do individuálně smluvně sjednaných bází v referenčním období, a zároveň zařazené podle Klasifikace do skupin vztažených k diagnóze uvedených v příloze č. 10, částech E a F k této vyhlášce. | |
| EM2023,EF | je celková hodnota vyžádané extramurální péče v rámci případů hospitalizací poskytovatelem vykázaných a zdravotní pojišťovnou uznaných, ukončených v referenčním období, zařazených podle Klasifikace do skupin vztažených k diagnóze uvedených v příloze č. 10, částech E a F k této vyhlášce, oceněná hodnotami bodu platnými v referenčním období včetně úhrady za zvlášť účtovaný materiál a zvlášť účtované léčivé přípravky. |
| CM2023,CZ–DRG,E | je počet případů hospitalizací přepočtených podle bodu 1.1 poskytovatelem vykázaných a zdravotní pojišťovnou uznaných, ukončených v referenčním období, zařazených podle Klasifikace do skupin vztažených k diagnóze uvedených v příloze č. 10, části E k této vyhlášce, vynásobených relativními váhami 2025 uvedenými v příloze č. 10, části E k této vyhlášce. |
| CM2023,CZ–DRG,EF | je počet případů hospitalizací přepočtených podle bodu 1.1 poskytovatelem vykázaných a zdravotní pojišťovnou uznaných, ukončených v referenčním období, zařazených podle Klasifikace do skupin vztažených k diagnóze uvedených v příloze č. 10, částech E a F k této vyhlášce, vynásobených relativními váhami 2025 uvedenými v příloze č. 10, částech E a F k této vyhlášce. |
| CM2023,CZ–DRG,C | je počet případů hospitalizací přepočtených podle bodu 1.1 poskytovatelem vykázaných a zdravotní pojišťovnou uznaných, ukončených v referenčním období, zařazených podle Klasifikace do skupin vztažených k diagnóze uvedených v příloze č. 10, části C k této vyhlášce, vynásobených relativními váhami 2025 uvedenými v příloze č. 10, části C k této vyhlášce. |
| CM2023,CZ–DRG,CE | je počet případů hospitalizací přepočtených podle bodu 1.1 poskytovatelem vykázaných a zdravotní pojišťovnou uznaných, ukončených v referenčním období, zařazených podle Klasifikace do skupin vztažených k diagnóze uvedených v příloze č. 10, částech C a E k této vyhlášce, vynásobených relativními váhami 2025 uvedenými v příloze č. 10, částech C a E k této vyhlášce. |
| ZSCZ–DRG | je základní sazba pro CZ-DRG, která se stanoví následovně: |
where:
| NMCMI | je nákladový modifikátor, který se pro |
CMI = CM2023, CZ-DRGmax (1; PPdrg, 2023)
where:
| CM2023,CZ–DRG | je počet případů |
| PPdrg,2023 | je počet případů |
and where other parameters contained in the variables ZSCZ- DRG and IZS2025, CZ-DRG, CE are parameters of implementation of the CZ- DRG with values according to the following table:
| Parametr | Název parametru | Hodnota |
|---|---|---|
| CZSCZ–DRG | Centrální základní sazba pro CZ-DRG | 81 000 |
| RKCE,horní | Horní risk-koridor | 0,15 |
| RKCE,dolní | Dolní risk-koridor | 0,1 |
| TSCE,horní | Horní tempo sbližování sazeb | 0,5 |
| TSCE,dolní | Dolní tempo sbližování sazeb | 0,5 |
5. Reimbursement of case flat rate according to CZK-DRG
5.1 The flat-rate payment shall include the services covered by the Classification in the groups related to the diagnosis listed in Annex 10, Parts B, D, F, G and H to this Decree.
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Regulation Information
| Citation | Decree No 314 / 2024 Coll., establishing the value of the point, the amount of the remuneration for the services paid and the regulatory restrictions for 2025 |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 30.10.2024 |
|---|---|
| Effective from | 01.01.2025 |
| Effective until | - |
| Status | Valid |
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